I'm writing about using a nicotine patch to treat an adolescent patient ("Smoking Cessation: All Patched Up," Advice, p.r.n., March 2007).* A reader questioned whether it was legal or ethical to use a nicotine patch for a 15-year-old patient, who can't legally buy cigarettes. I agree with your advice.

The Joint Commission requires that all hospital facilities be smoke-free. An adolescent who's suddenly cut off from her cigarettes will go through withdrawal, just as an adult would. Using a nicotine patch lets her focus on emotional and treatment issues without the distraction of withdrawal.

Use of nicotine patches is fairly standard in both psychiatric and addiction treatment facilities. These are highly controlled environments where the patient wouldn't have access to tobacco. The patch's strength is gradually decreased during the stay and is discontinued before the patient's discharge.